Achieving lipid targets within 12 months of an acute coronary syndrome: an observational analysis

Objectives: To assess lipid levels in people six or 12 months after hospitalisation with acute coronary syndrome (ACS); to identify factors associated with not achieving lipid level targets. Design, setting: Retrospective cohort study; analysis of data from CONCORDANCE, an Australian ACS registry, 2009-2018. Participants: Adult patients who had experienced confirmed ACS of cardiovascular origin, for whom serum lipid levels had been assessed on admission and six or 12 months after discharge. Main outcome measures: Not achieving lipid targets by most recent follow-up ( in order of priority: low-density lipoprotein cholesterol [LDL-C] <= 1.8 mmol/ L or total cholesterol <= 4 mmol/L); factors associated with not achieving target lipid levels. Results: Lipid levels measured at 6- or 12-month follow-up were available for 2671 of 10 578 people discharged from hospital alive; 1194 (45%) had not achieved lipid targets at their most recent follow-up, including 876 ( 73%) who had been prescribed intensive lipid-lowering therapy at discharge. People under 65 years of age, those using lipid-lowering therapy or with higher cholesterol levels on admission, patients prescribed fewer than four evidence- -based therapies or not prescribed intensive lipid-lowering therapy on discharge, and women were more likely to not reach lipid level targets. Conclusion: Almost half the patients did not achieve target lipid levels within 12 months of an admission to hospital with ACS. These people are at elevated risk of recurrent cardiovascular disease, and therapy could be optimised (eg, dose escalation, drug combinations, novel therapies) to improve outcomes.